Provider Demographics
NPI:1588851687
Name:RANDALL R MERCIER PA
Entity Type:Organization
Organization Name:RANDALL R MERCIER PA
Other - Org Name:RANDALL ROBERT MERCIER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:VAN METRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-744-8413
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0864
Practice Address - Street 1:630 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5920
Practice Address - Country:US
Practice Address - Phone:910-692-0873
Practice Address - Fax:910-295-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203442DMedicare PIN